Hearing preservation in patients with unilateral vestibular schwannoma who undergo stereotactic radiosurgery

Cancer ◽  
2012 ◽  
Vol 118 (21) ◽  
pp. 5441-5447 ◽  
Author(s):  
Jung Ho Han ◽  
Dong Gyu Kim ◽  
Hyun-Tai Chung ◽  
Sun Ha Paek ◽  
Chul-Kee Park ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation

Hearing preservation after stereotactic radiosurgery for vestibular schwannoma: A systematic review

2009 ◽  
Vol 16 (6) ◽  
pp. 742-747 ◽  
Author(s):  
Isaac Yang ◽  
Derrick Aranda ◽  
Seunggu J. Han ◽  
Sravana Chennupati ◽  
Michael E. Sughrue ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation

Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma

Cancer ◽  
2005 ◽  
Vol 104 (3) ◽  
pp. 580-590 ◽  
Author(s):  
Sun Ha Paek ◽  
Hyun-Tai Chung ◽  
Sang Soon Jeong ◽  
Chul-Kee Park ◽  
Chae-Yong Kim ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Gamma Knife ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Gamma Knife Stereotactic Radiosurgery

scholarly journals Hearing subclassification may predict long-term auditory outcomes after radiosurgery for vestibular schwannoma patients with good hearing

2016 ◽  
Vol 125 (4) ◽  
pp. 845-852 ◽  
Author(s):  
Seyed H. Mousavi ◽  
Ajay Niranjan ◽  
Berkcan Akpinar ◽  
Marshall Huang ◽  
Hideyuki Kano ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Pure Tone ◽  
Hearing Preservation ◽  
Class I ◽  
Tumor Control ◽  
Speech Discrimination ◽  
Pure Tone Average

OBJECTIVE In the era of MRI, vestibular schwannomas are often recognized when patients still have excellent hearing. Besides success in tumor control rate, hearing preservation is a main goal in any procedure for management of this population. The authors evaluated whether modified auditory subclassification prior to radiosurgery could predict long-term hearing outcome in this population. METHODS The authors reviewed a quality assessment registry that included the records of 1134 vestibular schwannoma patients who had undergone stereotactic radiosurgery during a 15-year period (1997–2011). The authors identified 166 patients who had Gardner-Robertson Class I hearing prior to stereotactic radiosurgery. Fifty-three patients were classified as having Class I-A (no subjective hearing loss) and 113 patients as Class I-B (subjective hearing loss). Class I-B patients were further stratified into Class I-B1 (pure tone average ≤ 10 dB in comparison with the contralateral ear; 56 patients), and I-B2 (> 10 dB compared with the normal ear; 57 patients). At a median follow-up of 65 months, the authors evaluated patients' hearing outcomes and tumor control. RESULTS The median pure tone average elevations after stereotactic radiosurgery were 5 dB, 13.5 dB, and 28 dB in Classes I-A, I-B1, and I-B2, respectively. The median declines in speech discrimination scores after stereotactic radiosurgery were 0% for Class I-A (p = 0.33), 8% for Class I-B1 (p < 0.0001), and 40% for Class I-B2 (p < 0.0001). Serviceable hearing preservation rates were 98%, 73%, and 33% for Classes I-A, I-B1, and I-B2, respectively. Gardner-Robertson Class I hearing was preserved in 87%, 43%, and 5% of patients in Classes I-A, I-B1, and I-B2, respectively. CONCLUSIONS Long-term hearing preservation was significantly better if radiosurgery was performed prior to subjective hearing loss. In patients with subjective hearing loss, the difference in pure tone average between the affected ear and the unaffected ear was an important factor in long-term hearing preservation.

scholarly journals Usefull Hearing Preservation Is Improved in Vestibular Schwannoma Patients Who Undergo Stereotactic Radiosurgery Before Further Hearing Deterioration Ensures

2021 ◽  
Author(s):  
Hideyuki Kano ◽  
Akiyoshi Ogino ◽  
Hao Long ◽  
Stephen Johnson ◽  
Andrew Faramand ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Initial Diagnosis ◽  
Speech Discrimination ◽  
Pure Tone Average ◽  
Younger Age ◽  
Grade Ii ◽  
Preservation Rate

Abstract IntroductionThe present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing.MethodsWe retrospectively analyzed 1447 VS patients who underwent SRS between 1992 to 2017. We identified 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS.ResultsThe serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (<55 years, p=0.012) and HM during observation (p<0.001) improved serviceable hearing preservation rates. Patients whose PTA increased >15 dB (p=0.011) or whose SDS declined >10% (p=0.024) had reduced serviceable hearing preservation rates.ConclusionsHearing deterioration during observation before SRS reduced long term hearing preservation rate in VS patients with GR grade I hearing at initial diagnosis. SRS before hearing deterioration was recommended for hearing preservation.

Impact of cochlear modiolus dose on hearing preservation following stereotactic radiosurgery for non–vestibular schwannoma neoplasms of the lateral skull base: a cohort study

2020 ◽  
Vol 133 (3) ◽  
pp. 736-741
Author(s):  
Lucas P. Carlstrom ◽  
Jeffrey T. Jacob ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Michael S. Oldenburg ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cohort Study ◽  
Skull Base ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Control Group ◽  
High Dose ◽  
Petroclival Meningiomas ◽  
Lateral Skull Base

OBJECTIVERadiation dose to the cochlea has been proposed as a key prognostic factor in hearing preservation following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). However, understanding of the predictive value of cochlear dose on hearing outcomes following SRS for patients with non-VS tumors of the lateral skull base (LSB) is incomplete. The authors investigated rates of hearing loss following high-dose SRS in patients with LSB non-VS lesions compared with patients with VS.METHODSPatients with LSB meningioma or jugular paraganglioma and serviceable pretreatment hearing who underwent SRS treatment during 2007–2016 and received a modiolus dose > 5 Gy were included in a retrospective cohort study, along with a similarly identified control group of consecutive patients with sporadic VS.RESULTSSixteen patients with non-VS tumors and a control group of 43 patients with VS met study criteria. Serviceable hearing, defined as American Academy of Otololaryngology–Head and Neck Surgery class A/B, was maintained in 13 non-VS versus 23 VS patients (81% vs 56%, p = 0.07). All 3 instances of hearing loss in non-VS patients were observed in cerebellopontine angle (CPA) meningiomas. Non-VS with preserved hearing had a median modiolus dose of 6.9 Gy (range 5.7–19.2 Gy), versus 7.4 Gy (range 5.4–7.6 Gy) in those patients with post-SRS hearing loss (p = 0.53). Sporadic VS patients received an overall median modiolus point-dose of 6.8 Gy (range 5.4–11.7 Gy).CONCLUSIONSThe modiolus dose threshold of 5 Gy does not predict hearing loss in patients with non-VS tumors undergoing SRS, suggesting that dosimetric parameters derived from VS may not be applicable to this population. Differential rates of hearing loss appear to vary by pathology, with paragangliomas and petroclival meningiomas demonstrating decreased risk of hearing loss compared to CPA meningiomas that may directly compress the cochlear nerve similarly to VS.

scholarly journals Impact of Cochlear Dose on Hearing Preservation following Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy for the Treatment of Vestibular Schwannoma

2017 ◽  
Vol 79 (04) ◽  
pp. 335-342 ◽  
Author(s):  
Lawrance Chung ◽  
Nolan Ung ◽  
John Sheppard ◽  
Thien Nguyen ◽  
Carlito Lagman ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Stereotactic Radiotherapy ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Hearing Preservation ◽  
Fractionated Stereotactic Radiotherapy ◽  
Retrospective Case

Objective The objective of this study was to examine the effect of cochlear dose on hearing preservation in stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) for vestibular schwannoma (VS). Design This is a retrospective case–control study. Setting This study was completed at the Ronald Reagan UCLA Medical Center, a university-affiliated tertiary care center. Participants Patients who underwent SRS (marginal dose of 12 Gy) or fSRT (marginal dose of 50.4 Gy) procedures for VS were included in the study. Main Outcome Measures The main outcome measure was hearing preservation. Audiometric data, when available, were used to determine the level of hearing according to the Gardner Robertson scale. Results A total of 38 patients (14 SRS and 24 fSRT) were analyzed. SRS patients with decreased hearing received a significantly higher minimum cochlear dose (7.41 vs. 4.24 Gy, p = 0.02) as compared with those with stable hearing. In fSRT patients, there were no significant differences in cochlear dose for patients with decreased hearing as compared with those with stable hearing. For SRS patients, who received a minimum cochlear dose above 6 Gy, there was a significant risk of decreased hearing preservation (odds ratio: 32, p = 0.02). Conclusion Higher minimum cochlear dose was predictive of decreased hearing preservation following SRS. Though the study is low powered, the radiation dose to the cochlea should be a parameter that is considered when planning SRS or fSRT therapies for patients with VS.

Vestibular Schwannoma: The Evolution of Hearing and Tumor Size in Natural Course and after Treatment by LINAC Stereotactic Radiosurgery

2015 ◽  
Vol 20 (6) ◽  
pp. 406-415 ◽  
Author(s):  
Christos Ikonomidis ◽  
Alessia Pica ◽  
Jocelyne Bloch ◽  
Raphael Maire
Keyword(s):  
Hearing Loss ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Conservative Management ◽  
Tumor Size ◽  
Hearing Preservation ◽  
Natural Course ◽  
Tumor Control ◽  
Initial Symptom ◽  
Cochlear Function

Objective: To review the natural course of tumor size and hearing during conservative management of 151 patients with unilateral vestibular schwannoma (VS), and to evaluate the same parameters for the part of the group (n = 84) who were treated by LINAC stereotactic radiosurgery (SRS). Methods: In prospectively collected data, patients underwent MRI and complete audiovestibular tests at inclusion, during the conservative management period and after SRS. Hearing was graded according to the Gardner-Robertson (GR) scale and tumor size according to Koos. Statistics were performed using Kaplan-Meier survival analysis and multivariate analyses including linear and logistic regression. Specific insight was given to patients with serviceable hearing. Results: During the conservative management period (mean follow-up time: 24 months, range: 6-96), the annual risk of GR class degradation was 6% for GRI and 15% for GR II patients. Hearing loss as an initial symptom was highly predictive of further hearing loss (p = 0.003). Tumor growth reached 25%. For SRS patients, functional hearing preservation was 51% at 1 year and 36% at 3 years. Tumor control was 94 and 91%, respectively. Conclusion: In VS patients, hearing loss at the time of diagnosis is a predictor of poorer hearing outcome. LINAC SRS is efficient for tumor control. Patients who preserved their pretreatment hearing presented less hearing loss per year after SRS than before treatment, suggesting a protective effect of SRS when cochlear function can be preserved.

The Effect of Prescription Isodose Variation on Tumor Control and Toxicities in Stereotactic Radiosurgery for Sporadic Vestibular Schwannoma: Propensity Score-Matched Case–Control Study

2021 ◽  
Author(s):  
Achiraya Teyateeti ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Eric J. Tryggestad ◽  
Paul D. Brown ◽  
...  
Keyword(s):  
Propensity Score ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Tumor Control ◽  
Gamma Knife Stereotactic Radiosurgery ◽  
The Impact ◽  
Prescription Isodose

Abstract Objective Vestibular schwannoma (VS) treated with Gamma Knife stereotactic radiosurgery (SRS) was typically performed at 50% isodose line (IDL50); however, the impact of IDL variation on outcomes is poorly understood. This study aimed to compare tumor control (TC) and toxicities between treatment at 40% (IDL40) and 50% (IDL50). Methods and Materials Sporadic/unilateral VS patients treated with SRS dose 12 to 14 Gy and prescription isodose volume ≤10cm3 were included. Propensity score matching was applied to IDL40 cohort to generate an IDL50 companion cohort, adjusting for age and prescription isodose volume. After exclusion of patients with follow-up <24 months, there were 30 and 28 patients in IDL40 and IDL50 cohorts, respectively. Results Median follow-up time was 96 months (24–225 months). Actuarial and radiographic TC rates were 91.8% and clinical TC was 96.2% both at 5 and 10 years. TC was higher in IDL40 cohort but not significant (96.4 vs. 86.7%; p = 0.243). Hearing preservation (HP) rates were 71.9 and 39.2% at 5- and 10-year intervals, with significantly higher rates of HP noted in IDL40 cohort (83.3 vs. 57.1% at 5-year interval; 62.5 vs. 11.4% at 10-year interval; p = 0.017). Permanent facial neuropathy occurred in two patients, both from the IDL50 cohort (3.5%). Rates of post-SRS steroid treatment or shunt placement for hydrocephalus were slightly higher in IDL50 patients (6.9 vs. 17.9%; p = 0.208 and 3.3 vs. 7.1%; p = 0.532). Conclusion For treatment of VS with SRS, dose prescription at IDL40 or IDL50 provides excellent long-term TC and toxicity profiles. IDL40 may be associated with improved long-term HP.

Useful hearing preservation is improved in vestibular schwannoma patients who undergo stereotactic radiosurgery before further hearing deterioration ensues

2021 ◽  
Vol 152 (3) ◽  
pp. 559-566
Author(s):  
Akiyoshi Ogino ◽  
Hao Long ◽  
Stephen Johnson ◽  
Andrew Faramand ◽  
Ajay Niranjan ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Hearing Preservation
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